Bridging the Gap Between Primary Care and Mental Health

Machado, Robert J; Tomlinson, Victoria

doi:10.3928/02793695-20111004-02

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…A large body of evidence demonstrates that the wider implementation of integrated and collaborative care models improves the management of mental health problems [24,25], improves continuity of care [26] and increases client satisfaction [27]. Collaborative care models are especially pertinent in the context of the deinstitutionalization of mental healthcare that is actively taking place in Lithuania [2].…”

Section: Discussionmentioning

confidence: 99%

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey

Jaruševičienė

Sauliūnė

Jaruševičius

et al. 2014

Int J Ment Health Syst

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BackgroundA large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners’ (GPs) experience in mental healthcare and their perceptions about how to increase their involvement in the field.MethodsIn this cross-sectional study, a 41-item questionnaire was distributed to a random sample of 797 Lithuanian GPs in order to investigate current practices in their provision of mental healthcare as well as their suggestions for the improvement of mental healthcare services in primary care.ResultsThe response rate was 52.2%. Three-quarters of the GPs agreed that they feel responsible for the management of mental health problems, but only 8.8% of them agreed that “My knowledge in mental healthcare is sufficient”. Psychiatrists were identified as the mental healthcare team specialists with whom 32% of the respondents discuss the management of their patients with a mental disorder. Collaboration with psychologists and social workers was almost threefold lower (11.6% and 12.5%). Capacity-building of GPs was found to be among the most promising initiatives to improve mental health services in primary care. Other strategies mentioned were policy level and managerial measures as well as strengthening the teamwork approach in mental healthcare.ConclusionsThis study found a low self-reported competence of GPs in mental healthcare and low collaboration among GPs and other specialists in providing mental healthcare. For the situation to improve in the country, these findings point to a need for strategies to improve GPs’ expertise and teamwork in mental healthcare.

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Section: Discussionmentioning

confidence: 99%

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey

Jaruševičienė

Sauliūnė

Jaruševičius

et al. 2014

Int J Ment Health Syst

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“…However, this leaves patients in a difficult situation when seeking PrEP prescription, especially if a psychiatrist is the only clinician whom they are seeing regularly as several PLMI may not have a regular primary care clinician (such as a FM physician). 18,19,45,46 This is a priority highlighted by the National HIV/AIDS Strategy and EHE plan, which specifically prioritize development of novel protocols to co-locate PrEP prescription with mental health care where PLMI are already engaged including psychiatric care settings. 47,48 The findings of this study underscore the need for training about PrEP that is focused specifically for psychiatrists, as well as development of practice models to facilitate PrEP linkage for PLMI.…”

Section: Discussionmentioning

confidence: 99%

Psychiatry and Family Medicine Residents’ Likelihood of Prescribing HIV Pre-Exposure Prophylaxis (PrEP) to Patients with Mental Illness and HIV Vulnerability

Bunting,

Feinstein,

Vidyasagar

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: People living with mental illness (PLMI) experience disproportionately high incidence of and vulnerability to HIV. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method, but data regarding prescription to PLMI are lacking. Psychiatrists may serve as important points of access for PrEP prescription for PLMI. Methods: We conducted a vignette-based study of residents in psychiatry and family medicine (FM) to assess likelihood of prescribing PrEP and assumptions about the fictional patient. The patients’ psychiatric diagnosis was varied (schizophrenia on LAI or oral antipsychotic, bipolar disorder, major depression) or a control condition without a psychiatric diagnosis. Results: A total of 439 residents participated. We found high percentages of psychiatry (96.8%) and FM (97.4%) residents were aware of PrEP. High percentages of psychiatry (92.0-98.1%) and FM (80.8-100%) residents indicated that PrEP was indicated for all patient conditions. Family medicine residents were more likely to prescribe PrEP to all experimental conditions compared to psychiatry residents. There was no difference in likelihood of prescribing to the control condition without a psychiatric diagnosis. The belief that PrEP prescription was out of the scope of practice was greater among psychiatry residents. Conclusions: A majority of psychiatry residents responded that PrEP was indicated for an array of patients with psychiatric diagnoses. However, psychiatry residents were broadly less likely to prescribe PrEP to patients with these diagnoses. The high percentage of psychiatry residents who reported that PrEP was indicated for all patients suggests additional training is needed to facilitate PrEP prescription by psychiatrists.

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“…Similar to other studies conducted in remote areas ( 37 ), these results show that nurses and social workers should be targeted first in the effort to improve care for individuals with CMDs. Studies have shown that giving nurses a greater role in the treatment and monitoring of individuals with depression significantly increases FHSS quality ( 38 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study

Lessard

Fournier

Gauthier

et al. 2015

International Journal of Circumpolar Health

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Background Changing Directions, Changing Lives, the Mental Health Strategy for Canada, prioritizes the development of coordinated continuums of care in mental health that will bridge the gap in services for Inuit populations.ObjectiveIn order to target ways of improving the services provided in these contexts to individuals in Nunavik with depression or anxiety disorders, this research examines delays and disruptions in the continuum of care and clinical, individual and organizational characteristics possibly associated with their occurrences.DesignA total of 155 episodes of care involving a common mental disorder (CMD), incident or recurring, were documented using the clinical records of 79 frontline health and social services (FHSSs) users, aged 14 years and older, living in a community in Nunavik. Each episode of care was divided into 7 stages: (a) detection; (b) assessment; (c) intervention; (d) planning the first follow-up visit; (e) implementation of the first follow-up visit; (f) planning a second follow-up visit; (g) implementation of the second follow-up visit. Sequential analysis of these stages established delays for each one and helped identify when breaks occurred in the continuum of care. Logistic and linear regression analysis determined whether clinical, individual or organizational characteristics influenced the breaks and delays.ResultsMore than half (62%) the episodes of care were interrupted before the second follow-up. These breaks mostly occurred when planning and completing the first follow-up visit. Episodes of care were more likely to end early when they involved anxiety disorders or symptoms, limited FHSS teams and individuals over 21 years of age. The median delay for the first follow-up visit (30 days) exceeded guideline recommendations significantly (1–2 weeks).ConclusionClinical primary care approaches for CMDs in Nunavik are currently more reactive than preventive. This suggests that recovery services for those affected are suboptimal.

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Bridging the Gap Between Primary Care and Mental Health

Cited by 8 publications

References 10 publications

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey

Psychiatry and Family Medicine Residents’ Likelihood of Prescribing HIV Pre-Exposure Prophylaxis (PrEP) to Patients with Mental Illness and HIV Vulnerability

Continuum of care for persons with common mental health disorders in Nunavik: a descriptive study

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